Nursing Home Advocates Urge States to Use Civil Monetary Penalties to Improve Residential Care

In 1986, Congress passed the Nursing Home Reform Act, which allowed the federal government the authority to issue financial penalties against nursing homes that failed to comply with standards of care required by Medicare and Medicaid. In 1995, the federal government implemented the use of civil monetary penalties (CMPs) against nursing facilities that provided poor care. Many states also passed laws allowing them to issue their own CMPs against nursing homes that failed to provide quality care to its residents. The purpose of CMPs was two-told. First, CMPs could be used as a deterrent for nursing homes providing substandard care. Second, the funds collected from CMPs could be used to finance innovative projects that could improve residential care in nursing homes.

How are Most States Using CMPs?

However, according to a 2006 report issued by the Long Term Care Community Coalition (LTCCC), an advocacy organization dedicated to improving nursing home care, CMPs are not being used as they were originally intended. While some states have used CMPs to fund projects to improve nursing home care, many states have difficulty determining exactly how much CMP moneys they were actually owed. In addition, while CMPs were issued by the government, some of the penalties were never collected or pursued. Moreover, some states simply put CMP funds, which are supposed to be handled separately, into a general fund while other states used CMP funding to finance projects totally unrelated to nursing home care. For instance, some states used CMPs to fund schools. From 1999 to 2005, 32 states spent $28 million in CMP funding. Much of the money was used to relocate patients, hire nursing home consultants, and fill temporary management positions. Only $10 million of the funds went towards projects directly related to improving nursing home care. As a result, the LTCCC argues that CMP funds are not being used effectively.

Are Some States Using CMPs Effectively to Improve Nursing Home Care?

In some cases, however, states did use CMP finances to fund innovative programs designed to improve the quality of care in nursing homes. For instance, Delaware used CMP funds to provide a training workshop about bedsores and restraints. Florida used CMP money to research ways to train staff to deal with mentally ill patients more effectively. Iowa conducted recruitment initiatives and retention programs for certified nurse’s assistants. Indiana used the funds to train staff about Alzheimer’s and dementia care. Minnesota produced a brochure and training video on how to properly use restraints. Maryland even funded a pets-on-wheels initiative to improve residents’ quality of life.

What Can be Done to Ensure CMPs are Being Used to Improve Care?

In 2005, 46 states reported a total of $60 million in CMP funds that were not being used. In other cases, such funds were being used to finance projects unrelated to nursing home care. As a result, the LTCCC is urging states to require that such funds be spent directly on developing innovative ways to improve nursing home care for residents. The organization has also recommended that a uniform system be put into place to allow states to see how much CMP money they are owed and to take appropriate actions to collect the money. Finally, the LTCCC recommends that such money be used for its original and intended purpose–to fund projects that will directly impact the improvement of care in nursing facilities.